Mycobacterial, Fungal, & Parasitic Infections Medications for Infection ADN 110/cohort 131

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OVERVIEW Mycobacterium tuberculosis (TB) ◦ Slow growing ◦ Minimum 2 medications Parasitic infections ◦ metronidazole Systemic & superficial mycoses ◦ Antifungal medications ADN 110/cohort 133

ANTIMYCOBACTERIAL (ANTITUBERCULOSIS) Isoniazid Other Pyrazinamide Ethambutol Rifapentine ADN 110/cohort 134

Tuberculosis TB close to eradication; new resistant strain developed in immunocompromised individuals and immigrants to the U.S. Drug therapy is given in two forms: ◦ Preventive therapy ◦ Active therapy ADN 110/cohort 135

Antitubercular Agents Tuberculosis (TB) ◦ Mycobacterium tuberculosis  An aerobic bacillus  Requires oxygen to survive Antitubercular agents treat all forms of Mycobacterium ADN 110/cohort 136

Purpose Expected Action ◦ Highly specific for mycobacterium ◦ Inhibits growth Therapeutic Use ◦ Active & latent TB ADN 110/cohort 137

TB: Preventive Therapy Preferred agent ◦ INH (Isoniazid) ◦ Known as chemoprophylaxis  Safest  Low cost  Action: tuberculostatic and tuberculocidal  Treatment: 18 months to 2 years ADN 110/cohort 138

Complications Peripheral neuropathy Hepatotoxicity Hyperglycemia Nausea Skin rashes Contraindications/Precautions ◦ Contraindicated – liver disease ◦ Caution – geriatrics, DM, alcohol use disorder ADN 110/cohort 139

Interactions Phenytoin Alcohol ADN 110/cohort 1310

ANTIMYCOBACTERIAL (ANTITUBERCULOSIS) Rifampin ADN 110/cohort 1311

Purpose Expected Action ◦ Bactericidal Therapeutic Uses ◦ Gram positive & gram negative bacteria ◦ Combined with at least one other antituberculosis medication ADN 110/cohort 1312

Complications Discoloration of body fluids Hepatotoxicity Mild GI Contraindications/Precautions ◦ Caution – liver dysfunction ADN 110/cohort 1313

Interaction Warfarin, oral contraceptives, protease inhibitors & NNRTIs Isoniazid & pyrazinamide ADN 110/cohort 1314

ANTIPROTOZOALS Flagyl ADN 110/cohort 1315

Purpose Expected Action ◦ Bactericidal activity Therapeutic Use ◦ Protozoal infections ◦ Obligate bacteria ◦ Prophylaxis for surgical procedures in high risk clients ◦ H. pylori ADN 110/cohort 1316

Complications GI Darkening of urine CNS symptoms Contraindications/Precautions ◦ Contraindicated – active CNS disorders, blood dyscrasias, lactation, first trimester ◦ Caution – renal, cardiac, or seizure disorders, geriatrics ADN 110/cohort 1317

Interactions Alcohol Warfarin ADN 110/cohort 1318

ANTIFUNGALS Amphotericin B Ketoconazole Other Flusytosine Nystatin Miconazole Clotrimazole Terbinafine Fluconazole Griseofulvin ADN 110/cohort 1319

Fungi Contracted ◦ Air ◦ Skin to skin Due to normal flora being killed off: ◦ Antibiotics ◦ Corticosteroid therapy ◦ Antineoplastic agents ◦ Suppressed immune system ADN 110/cohort 1320

Mycotic Infections Three general types ◦ Cutaneous ◦ Subcutaneous ◦ Systemic (can be life threatening ADN 110/cohort 1321

Antifungal Agents Treatment ◦ Antibiotic therapy will not work. ◦ Requires prolonged treatment  Human cell structure resembles fungi cell structure. Action ◦ Antifungal agents take advantage of the slight differences of the cell structu.res ADN 110/cohort 1322

Purpose Expected Action ◦ Acts on fungal cell membranes ◦ Fungistatic or fungicidal Therapeutic Use ◦ Systemic fungal infection ◦ Nonopportunistic mycoses ◦ Superficial fungal infections ADN 110/cohort 1323

Complications Infusion reactions Thrombophlebitis Nephrotoxicity Hypokalemia Bone marrow suppression Ketoconazole ◦ Hepatotoxicity ◦ Effects on sex hormones ADN 110/cohort 1324

Contraindications/Precautions Contraindicated – renal dysfunction ADN 110/cohort 1325

Interactions Aminoglycosides Amphotericin B Multiple medications ◦ Digoxin ◦ Warfarin ◦ sulfonylurea ADN 110/cohort 1326